BULGARIA-MENTAL HEALTH INFO

Enhancing Social Cohesion through Strengthening Community Mental Health Services in South Eastern Europe

Dr. Hristo Hinkov, Country project manager for Stability Pact – Bulgaria

(from the IEM editor) The following text is an excerpt from Dr. Hinkov’s presentation on the III SEE Mental Health Policy Forum held in Sofia 2006. It explains their experience with the implemented project of opening a Pilot Center for Mental Health in an old building (adaptation), training of the staff and equipping the center.

After negotiations with the municipality and additional information about the existing facilities, a decision to change the original plan toward reconstruction instead of construction of a new building was taken. It is based on estimations of the terms, deadlines and procedures which will last more that acceptable. That decision is also based on the recommendations of the two consultants who visited Blagoevgrad in September. The new option envisages rehabilitation and renovation of the existing facility for ambulatory care, which is part of the psychiatric dispensary.

After hiring the new staff of the day-care center by the local Agency for Social Assistance (ASA), the unit started officially its activities on 01. August 2005. Although number of discussions and meetings were organized prior to opening the Day-care center in order to establish a good cooperation between the “medical” and “social” part of the emerging CMHC, still there are many misunderstandings and pitfalls in the integration of the two staffs in one interdisciplinary team. Among many reasons for that, one is because of the different sources for financing, which require a separate administration. Although the final beneficiary is the Municipality, which is on a position to support and even to create such integration, still there were decisions taken without consultancy with the other partners (the CPM, the manager of the Dispensary etc.).


As a result of that lack of coordination, the person appointed for the administrative management of the Day care center is not from the team of the Dispensary. She is also responsible for all the social services in the region financed by the Agency. That situation could reflect on the everyday work of the Center if the methodological guidance does not come from the medical service. In order to guarantee efficiency, the mainstream of the customers must be referred by the outpatient ward of the Dispensary, which was not the case in the first days after the beginning.

The way out of the situation seems to be on two levels – local and central. The local level solution is strict implementation of the program Coordination of care, which was part of the initial training modules held in the early spring of 2005. The Coordination of care (or Case management) program must be headed by medical professional (in that particular case it is the chief nurse of the Dispensary). Another solution would be implementation of the information system based on defined functional characteristics of the whole CMHC including the medical and social part.

The central level includes negotiations between Ministry of Health and Ministry of Labor and Social Policy, including ASA. As a result of that, the two ministers signed a framework contract for cooperation and coordination of the activities regarding the people with mental health problems. These steps, taken between October and December 2005, reflected on the level of occupation of the Day care center, which increased considerably during the last two months.